Special Session 1 - Striving for Clinical Excellence in HKUMed

Pain, agitation, and delirium occur frequently in ICU patients. Prompt recognition and treatment help optimize ICU patient outcomes. The Society of Critical Care Medicine (SCCM) published guidelines detailing best practices for managing pain, sedation, and delirium in ICU patients to facilitate ventilator weaning, sleep, and early mobilization of patients. The ICU liberation's ABCDEF bundle was created to help translate these guideline recommendations into clinical practice.


In several large, multicenter trials, improved bundle performance leads to improved ICU patient outcomes and lower healthcare costs. The SCCM's ICU Liberation Collaborative, which included over 15,000 adult ICU patients from 68 U.S. hospitals, showed that bundle implementation is associated with significant improvements in survival, duration of mechanical ventilation (MV), delirium and coma, ICU readmissions, and discharge disposition of ICU survivors. Other studies have similarly shown that bundle implementation is associated with improved survival, more delirium and coma free days, reduced ICU LOS, MV duration, and benzodiazepine use, and a lower prevalence of PICS. Bundle performance also helps to promote interprofessional (IPT) teamwork and collaboration in the ICU, and patient and family-centered care.


In 2022, SCCM surveyed ICU clinicians and leaders to assess current ICU liberation bundle practices, to identify gaps in bundle adoption and sustainability, and best practices for improving bundle compliance. This survey showed significant improvements in bundle adoption and compliance since the Covid-19 pandemic, but significant barriers remain. A lack of leadership engagement and buy-in was the most significant barrier to bundle implementation and compliance across all bundle elements, while executive sponsorship of the bundle and strategic goal alignment significantly facilitated bundle compliance. Other barriers included a lack of ICU staff buy-in, poor staff communication, and a lack of staff education about the bundle. Other facilitators of bundle compliance included ICU provider education, daily IPT rounding, workflow integration using bundle champions, order sets, and rounding checklists/goal sheets.

In public ICUs, where resources are often limited and patient demand is high, triage decisions typically adhere to strict utilitarian principles-prioritizing individuals with the greatest likelihood of survival and long-term benefit. To allocate scarce resources fairly and efficiently, triage frameworks commonly consider factors such as resource intensity, patient frailty, and the potential reversibility of the acute illness. However, these criteria have been criticized for systematically disadvantaging certain populations-particularly elderly patients and those with underlying malignancies-who may be perceived as having poorer prognoses, often without sufficient consideration of individual clinical variability.
In contrast, private ICUs may apply different triage approaches, shaped by greater resource availability, institutional discretion, and, at times, the financial capacity of patients or families. This divergence raises important ethical concerns about equity, consistency, and access to care across different healthcare settings.
This session uses the application of ECMO in elderly and cancer patients as a case study to examine how differing triage philosophies in public versus private sectors influence clinical decision-making, patient outcomes, and ethical considerations. 

There have always been inequalities in access to healthcare in particular cancer treatment across countries and regions in the world. The differences in regulatory drug approval process, drug pricing strategies and governmental healthcare expenditures are main reasons for such phenomena. We should stay aware of such nuance so that we can look at the most personalised therapy for our cancer patients, so that they can get receive the most appropriate and affordable treatment for their ever-changing diseases.


In this presentation, case sharing on how to alleviate the disparity in accessing to different targeted therapies and other personalised cancer treatment between Hong Kong and the mainland will be illustrated. Governmental and non-governmental strategies on access to some novel cancer therapies across the border will be discussed. Cross-border patient referral should also be streamlined to facilitate seamless and timely cancer care. The importance of personalised cancer medicine through multidisciplinary discussion and management as well as establishment of consensus statements and recommendation guidelines will also be emphasised.

Hepatitis E virus (HEV) is one of the most common causes of viral hepatitis globally. The infection is particularly severe in immunocompromised persons such as transplant recipients in whom infection can turn chronic. Fortunately, chronic hepatitis E is treatable with oral ribavirin. In 2018, we discovered for the first time that rat hepatitis E virus, a highly prevalent pathogen in street rats, can infect humans. This discovery subsequently enabled clinical recognition of rat hepatitis E as the causative pathogen in patients with unexplained hepatitis, many of whom could be cured with antivirals. We also discovered that the most common cause of human hepatitis E in Hong Kong (Paslahepevirus balayani genotype 4), which is a foodborne infection from swine, frequently causes chronic infections in immunocompromised patients that progress to liver fibrosis and cirrhosis if left untreated. 
This presentation will detail the evolution and development of hepatitis E clinical services in the Hospital Authority. The diagnostic algorithm of hepatitis E in Hong Kong has historically been limited to IgM antibody testing, which is insensitive for diagnosis of rat hepatitis E and chronic HEV infections. Therefore, we developed quantitative RT-PCR assays for HEV that have since been adopted by Hospital Authority. These tests have filled the gap for diagnosis of hepatitis E, public health surveillance of rat hepatitis E (with demonstrable impacts on patient health and rodent disinfestation efforts in the city), and monitoring of chronic hepatitis E infection in transplant recipients. We have also set up genotypic resistance testing for management of challenging cases of ribavirin-refractory hepatitis E. We provide specialist consultation services for hepatitis E in immunocompromised persons on inpatient, outpatient, and telephone consultation basis. Our clinical services have incorporated innovative bench-to-clinic solutions such as the world's first application of molnupiravir, a SARS-CoV-2 drug, for the treatment of chronic hepatitis E. 

Indocyanine Green (ICG) binds to albumin and is metabolized by the liver. It absorbs near-infrared light and emits fluorescence, making it valuable in high-definition imaging systems. In upper gastrointestinal surgery, ICG is primarily used for tissue perfusion assessment (angiography), anatomical visualization, tumor localization, and lymph node mapping (lymphography).
A promising advancement in fluorescence-guided surgery involves using different wavelengths to enhance imaging. The Near Infrared II range (1,000–1,700 nm) improves tissue penetration, reduces noise, and produces sharper images, as demonstrated in preclinical studies. Additionally, molecular imaging probes beyond ICG are being explored for surgical guidance, cancer staging, and recurrence detection. However, target markers remain limited in upper GI surgery, and new probes lack the established safety profile of ICG.
Beyond fluorescence imaging, augmented reality (AR) and artificial intelligence (AI) are transforming surgical navigation and training. AI systems can recognize anatomical structures and surgical steps, aiding novice surgeons and paving the way for automated procedures in select scenarios.
In conclusion, fluorescence-guided surgery and AI/AR-assisted navigation represent exciting frontiers with vast potential for innovation in surgical precision and outcomes.